Healthcare Provider Details

I. General information

NPI: 1689354193
Provider Name (Legal Business Name): SPRING INN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 LOCH RAVEN BLVD
BALTIMORE MD
21239-2936
US

IV. Provider business mailing address

5715 LOCH RAVEN BLVD
BALTIMORE MD
21239-2936
US

V. Phone/Fax

Practice location:
  • Phone: 443-770-6564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DENA BARNWELL
Title or Position: OWNER
Credential: MS, CHES, CCHW
Phone: 443-770-6564